Healthcare Provider Details

I. General information

NPI: 1427879550
Provider Name (Legal Business Name): CRESCENT BOULEVARD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24330 SAFFRON FIELD LN
SPRING TX
77373-5337
US

IV. Provider business mailing address

24330 SAFFRON FIELD LN
SPRING TX
77373-5337
US

V. Phone/Fax

Practice location:
  • Phone: 971-348-1411
  • Fax:
Mailing address:
  • Phone: 971-348-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. WAHAB OLAIYA ALABI
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 971-348-1411